South Africa may not have enough doctors to fight COVID-19. But we could be making better use of those we have. Here’s how.

A pharmacist uses telemedicine to consult with patients in Johannesburg who access medication via ATMs. (Right to Care)

The United Kingdom is taking immediate steps to bring newly graduated and foreign-trained doctors into the health system as cases of the new coronavirus spiral. Could South Africa do the same before the health system becomes overwhelmed?

COMMENT

Across the world, healthcare workers are putting themselves on the frontline. But in South Africa, the Health Professions Council of South Africa (HPCSA) may not have yet given them all the tools they’ll need to win the fight against COVID-19.

Chris Hopson heads up the body that represents hospital administrators under the United Kingdom’s publicly funded healthcare system, the National Health Service (NHS). In March, he told CNN that London was facing a “continuous tsunami” of coronavirus patients.

Doctors in the country’s capital had one piece
of advice for colleagues who have yet to be inundated with coronavirus cases:

Additionally, newly graduated medical students and young doctors who have not yet completed internships, usually needed to practice independently in the UK, can also receive provisional registration to serve on the frontlines of the COVID-19 response.

Five ways South Africa can put more healthcare workers in the field. Now.

Registration of locally-trained healthcare
workers continues as usual during South Africa’s lockdown.

The HPCSA should be looking at more ways to increase the health workforce now, which may include:

Temporarily registering foreign-qualified healthcare workers already in the country to act as “acute care assistants” to work alongside registered doctors in emergency units;

Offering non-practising workers rapid re-registration;

Granting junior doctors who have not been placed for internship or community service a provisional practice license to join frontline work;

Relaxing restrictions on scopes of practice between specialities and professions to recognise that in times like these, certain specialists may have to function outside of their scopes of practice to assist in emergencies. Task sharing, meanwhile, may mean that professions such as nurses, may also need to function outside of their scopes of practice. This would require liaison with the South African Nursing Council and other regulatory bodies;

Facilitating the ability to practice for healthcare workers who, because of underlying conditions or age, may be at an increased risk of developing severe COVID-19 disease. This would mean promoting the use of telemedicine, which entails remote medical assessment and includes telephone and video consultation.

It’s time to telemedicine for real

The HPCSA’s stance on telemedicine has long been contentious, and even in 2010, researchers critiqued both the council’s definition of and approach to telemedicine, writing in the South African Journal of Bioethics and Law.

As the lockdown started, the HPCSA initially
elected to reiterate their stance on telemedicine, limiting the use of
telemedicine only to patients with whom healthcare workers had existing
relationships.

The guideline does not, however, allow for the practitoner to weigh the interests of the patient against the interests of the community – and this is a crucial point.

The HPCSA will need to go further to provide for the use of telemedicine which enables remote assessment and management of mild COVID-19 disease, in order to reduce the risk that infected patients come into contact with other patients at our clinics and hospitals.

Virtual consultations may also be a safeguard for vulnerable patients, so that they can be assessed via the phone or video chats as opposed to at health facilities where they can potentially be infected. These facilities may also allow healthcare workers who have been quarantined or who are in isolation to keep practising while at home. The same could be said for healthcare workers who themselves have underlying conditions that put them at risk for serious COVID-19 disease.

Remote consultations may also help decrease
the need for personal protective equipment, such as masks, goggles and gowns,
which is currently in short supply globally.

Finally, the explicitly temporary nature of these
guidelines, with the possibility that the council may revert back to a highly
restrictive stance on telemedicine in future, is worrying, as this may deter
investment in infrastructure and training for remote consultations.

Telemedicine may not be perfect, but during the pandemic, we cannot ignore it. The UK, Australia and China are already among the countries that have embraced this on a massive scale during the COVID19 outbreak.

In South Africa, the HPCSA also needs to
support reliable services on which health workers can communicate with one
another and discuss cases to get advice. Currently, much of this happens on
general platforms like WhatsApp, but also increasingly through tailor-made apps
such as Vula.

The HPCSA’s new guidance in the time of the
outbreak is a step in the right direction, but it may need to go further to
protect the public and enable health professionals. Let’s hope that the council
embraces its unique position to lead many enabling regulations in a time of
crisis.

Koot Kotze is a South African medical doctor and doing his doctoral research in Primary Health Care, with a focus on healthcare management in South Africa, at the University of Oxford.

Koot Kotze is a South African medical doctor and completing his doctoral research in primary health care, with a focus on healthcare management in South Africa, at the University of Oxford. Follow him on Twitter @kootkotze.